Elhage Tania, Lyons Matthew C, Roe Justin P, Nguyen Luc, Salmon Lucy J, Olesnicky Ben
School of Medicine, University of Notre Dame, Darlinghurst, Sydney, Australia.
North Sydney Orthopaedic and Sports Medicine Centre, Suite 2 The Mater Clinic, 3-9 Gillies St Wollstonecroft, NSW, Australia.
J Orthop. 2024 Dec 11;65:31-35. doi: 10.1016/j.jor.2024.12.008. eCollection 2025 Jul.
Adductor canal blocks (ACBs) have been associated with reduced pain following total knee arthroplasty (TKA). There is a paucity of evidence regarding whether these early differences impact longer term outcomes. This study aimed to identify whether using ACB in TKA was associated with improvements in both early and late outcomes.
Patients who underwent a unilateral TKA between 2021 and 2022 were retrospectively assessed for pain scores, time to first mobilization and opioid use over the first 72 h. At 6 weeks, complications, pain scores and opioid use were assessed. At 12 months validated patient reported outcome measures (PROMs) and patient satisfaction with their surgery were assessed.
262 unilateral TKA, of whom 129 received ACB (ACB group) and 133 did not (control group) were assessed. The ACB group had significantly lower median day 1 pain (median difference -0.44 (-0.09 to -0.79), p = 0.015). There was no significant difference between groups for pain after 24 h, time to mobilization or opioid use over 72 h. There was no significant difference in pain (p = 0.892), opioid use (p = 0.913) or complications (p = 0.348) at 6 weeks, or median change in PROMs (p = 0.436 and p = 0.307), opioid use (p = 0.187), or satisfaction with surgery (p = 0.262) at 12 months.
ACBs were associated with a clinically insignificant difference in median pain on day 1. there was no association with pain after 24 h, opioid use, time to mobilization or longer term outcomes. Our findings do not support the use of routine ACB during TKA.
收肌管阻滞（ACB）与全膝关节置换术（TKA）后疼痛减轻相关。关于这些早期差异是否会影响长期预后，证据不足。本研究旨在确定在TKA中使用ACB是否与早期和晚期预后的改善相关。
对2021年至2022年间接受单侧TKA的患者进行回顾性评估，记录其术后72小时内的疼痛评分、首次活动时间和阿片类药物使用情况。在术后6周，评估并发症、疼痛评分和阿片类药物使用情况。在术后12个月，评估经过验证的患者报告结局指标（PROMs）以及患者对手术的满意度。
共评估了262例单侧TKA患者，其中129例接受了ACB（ACB组），133例未接受（对照组）。ACB组术后第1天的中位疼痛明显更低（中位差异-0.44（-0.09至-0.79），p = 0.015）。两组在术后24小时后的疼痛、活动时间或72小时内的阿片类药物使用方面无显著差异。术后6周时，两组在疼痛（p = 0.892）、阿片类药物使用（p = 0.913）或并发症（p = 0.348）方面无显著差异；术后12个月时，两组在PROMs的中位变化（p = 0.436和p = 0.307）、阿片类药物使用（p = 0.187）或手术满意度（p = 0.262）方面也无显著差异。
ACB与术后第1天的中位疼痛存在临床上无显著意义的差异。与术后24小时后的疼痛、阿片类药物使用、活动时间或长期预后无关。我们的研究结果不支持在TKA期间常规使用ACB。
